Hot Debates on PSA and its Best Possible Use Continue                                                 
    Chin-Ti Lin, M.D., certified urologist, award-winning author, speaker, and copywriter


    Due to over-diagnosis and over-treatment of prostate cancer resulting from free battle of hypocrisy and commercialism under the blessing
    and cursing of free society, debates for and against PSA use have been heating up especially over the past six years.

    In 2008, the US Preventive Services Task Force (USPSTF) issued: All men after 75 should not undertake PSA screening,  and in May 2012, it
    announced its final recommendation: All men should not have PSA test.

    The bomb-shelling domino effect from its discouraging PSA use have shattered many people's minds and made the public becomes the
    victims of the once celebrated PSA after its discovery in 1970 and mixed application over the past 45 years.

    Truly, PSA use has led to over-diagnose and over-treat many men through the overwhelming evil power of hypocrisy and commercialism to
    forge political and financial gain leading to its overuse, misuse, and abuse.

    Where is the balancing point of proper use to support its merits without flatly throwing it into the useless ditch – medical waste basket?

    What should be the fair stand for a urologist at the forefront of managing, supporting, and battling the disastrous and lethal effects on the
    victims of prostate cancer?

    Here are the American Urological Association (AUA)'s stand which I support, adopt, adapt to as follows:

    1. Prostate cancer is known as the most common cancer of men, and the second-leading cause of cancer death in men.

    2. The goal of prostate cancer testing is not only to prevent mortality but even more so to prevent the attendant mortality coming from
       metastatic prostate cancer. Metastatic prostate cancer can lead to significant bone pain, pathologic fractures, and urinary tract
       obstruction – and a potentially painful death.

    3. According to SEER (Surveillance Epidemiology End Result) data, in 1990 the newly diagnosed metastatic prostate cancer was 67 per
       100,000 and in 2005 it had dropped to 23 per 100,000 – a 66 percent decrease.

    4. Models developed by the NIH-funded Cancer Intervention and Surveillance Modeling Network (CISNET) prostate group have
       demonstrated that early detection through screening could account for approximately 45% to 70% of the decline in prostate cancer
       mortality under a “stage-shift” mechanism for screening benefit.

    5. The Goteborg Trial showed a substantial 44 percent relative risk reduction in prostate cancer mortality occurring in men 50-64 years
       of age after a median of 14 years. Importantly, the risk reduction occurred in a setting where many of the patients were not
       aggressively treated for prostate cancer, indicating that the harm of PSA-based screening can, in fact, be minimized by good clinical
       practice.

    6. In 1990, the age-adjusted death rate from prostate cancer was 39 per 100,000; in 2009, it was 18.5 per 100,000 men.

    7. Not all prostate cancers require active treatment and not all are life-threatening. The decision to proceed with active treatments
       should be made after exploring and discussing the potential option in detail with their urologists and then determine if they need and
       prefer active treatment or just active surveillance.

    8. The bottom line is, in order to achieve the best possible outcome, that we needs to confirm if prostate cancer does exist at its
       treatable stage so we can treat it effectively. Currently, we solely rely on judicious use of PSA test and prostate biopsy.

    Reminding each other,  remember: “There is no magic in medicine and life. If any, that is to apply currently available knowledge, skill,
    technology, medication, and common sense at a reasonable time in a reasonable way to a reasonable person. Then we hope the possible
    best and have to move along.” So, let's work together in search for the possible best care although something best or perfection would never
    arrive.  



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